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Cancer Cytopathol. 2015 Jun;123(6):373-81. doi: 10.1002/cncy.21542. Epub 2015 Apr 17.

Prospective evaluation of p16/Ki-67 dual-stained cytology for managing women with abnormal Papanicolaou cytology: PALMS study results.

Author information

1
Laboratoire Cerba, Cergy Pontoise, France.
2
CytoMol, Frankfurt, Germany.
3
European Institute of Oncology, Milan, Italy.
4
North Bristol NHS Trust, Bristol, United Kingdom.
5
Algemeen Medisch Laboratorium BVBA, Sonic Healthcare, Antwerp, Belgium.
6
synlab MVZ Pathologie Mannheim GmbH, Mannheim, Germany.
7
Department of Pathology, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain.
8
Acomed statistik, Leipzig, Germany.
9
Roche mtm laboratories, Mannheim, Germany.
10
Ventana Medical Systems Inc, Tucson, Arizona.

Abstract

BACKGROUND:

Testing for the presence of the human papillomavirus (HPV) is widely accepted for triaging Papanicolaou cytology results categorized as atypical squamous cells of undetermined significance (ASC-US). In contrast, HPV testing has limited use in triaging cytological low-grade squamous intraepithelial lesions (LSILs) due to prevalence rates of typically >80%. In the current study, the authors assessed the diagnostic performance of p16/Ki-67 dual-stained cytology in triaging ASC-US and LSIL cases within the prospective, multicentric Primary ASC-US LSIL Marker Study (PALMS).

METHODS:

A total of 575 ASC-US cases and 529 LSIL cases from a cohort of 27,349 women who were prospectively enrolled into the PALMS study in 5 European countries were tested with p16/Ki-67 dual-stained cytology and Hybrid Capture 2 (HC2) HPV testing. Colposcopy-guided biopsy results of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) were used as clinical endpoints.

RESULTS:

p16/Ki-67 dual-stained cytology demonstrated comparable (ASC-US: 94.4% for dual-stained cytology vs 100% for HC2 testing; P = .317) or lower (LSIL: 85.7% for dual-stained cytology vs 98.4% for HC2 testing; P = .005) sensitivity for CIN2+, but higher levels of specificity compared with HC2 HPV testing in both ASC-US (78.7% vs 60.4%; P<.001) and LSIL (53.3% vs 15.6%; P<.001) cases. Positive predictive values for CIN2+ were substantially higher for dual-stained cytology versus HC2 HPV testing, especially in LSIL, and in ASC-US cases for women aged <30 years.

CONCLUSIONS:

The clinical usefulness and efficiency of triaging women with ASC-US or LSIL Papanicolaou cytology results by p16/Ki-67 dual-stained cytology testing has been confirmed in this prospective, pan-European study. The high positive predictive value of dual-stained cytology for the presence of high-grade CIN may help to reduce the number of unnecessary colposcopy referrals.

KEYWORDS:

CINtec PLUS; Primary ASC-US LSIL Marker Study (PALMS); atypical squamous cells of undetermined significance (ASC-US); cervical cytology; human papillomavirus (HPV); low-grade squamous intraepithelial lesion (LSIL); p16/Ki-67 dual-stained cytology; triage

PMID:
25891096
DOI:
10.1002/cncy.21542
[Indexed for MEDLINE]
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